Successful Advocacy for Care Partner Cannulation in a Hospital Stay

This blog post was made by Dawn Smith Bates on September 14, 2023.
Successful Advocacy for Care Partner Cannulation in a Hospital Stay

Not Just “A Bug”

jimmie in hospital bed

Jimmie and I were at a lobby day when he started to not feel good. That afternoon after we were home, he began to get sick with vomiting, diarrhea, and a fever. He felt it was “just a bug,” and didn’t think he needed to go to a doctor. After a few days of this, I insisted he be seen and took him to the ER. They did bloodwork, stool specimen, chest X-ray, and a CT scan without contrast and found gallstones stuck in his bile duct, causing a blockage that was now infected.

He was admitted to be transferred to the University of Iowa Hospital the following day after dialysis. Our home hospital has always allowed me as his care partner to cannulate him. So, I was comfortable with his care there. He was transferred the following afternoon. When we arrived, we were visited by multiple teams—Internal Medicine, Surgery, and Nephrology.

Hospital Cannulation Policy

When the first Nephrologist came in, I explained that we do home hemodialysis and we would prefer for me to cannulate his access for his treatments. We were told no, that the nurses “would take great care of him.” I stated the importance of having one person cannulate to ensure the health of his fistula. I was then told “it was against their policy.”

The next day, a different Nephrologist came in and again we explained that we do home hemodialysis and I have been the only one who has cannulated Jimmie’s access in the last 14 years and have never infiltrated him. We were again told, no, it was against their policy.

Asking Questions

dawn and jimmie happy

I asked what was the policy? And, could I have a copy or see a copy of this policy? He said he would have to talk to the Attending. Later that day, the Attending came in, and once again I asked about cannulating Jimmie’s access. She said I could not, and when I asked why, she said, “Let me explain.” She stated that since COVID, they did not allow anyone but the patient and the staff in the dialysis unit.

This made perfect sense to me, and as I listened, I thought of something outside of the box. I told her I completely understood the policy and agreed we need to keep those patients safe, but what if I cannulated Jimmie in his room, then saline-locked his lines and they could take him up to the dialysis unit?

Success!

The Attending said she thought that could work and she needed to talk to the nurses about it. Early the next morning, the nurse came in at 7:15 and said they would be coming for Jimmie in about 15 minutes for dialysis. I explained the conversation I’d had with the Attending, and she said, “Let me make a call.” She came back 15 minutes later and said I would be allowed to go to the dialysis unit and cannulate Jimmie, and leave while he did his treatment.

I was so grateful that this Attending understood what I was saying and how important it was to Jimmie for me to cannulate him. He had so much pain before they removed the gallstones and gallbladder. His biggest regret was waiting to go to the doctor. As a dialysis patient, he was busy living and just put it off.

And, the Outcome

jimmie is feeling better

Now, Jimmie is feeling much better and is ready to get back to traveling and thriving!

dawn and jimmie traveling

Comments

  • Robert Kirsch

    Oct 15, 2023 3:38 PM

    I’m looking to try home dialysis
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  • Jeff Stumpe

    Oct 14, 2023 1:09 AM

    I had self-cannulated up to 5 different buttonhole access sites in my three-vessel fistula for over 10-1/2 years as a home hemodialysis patient when I got the call and accepted a deceased donor kidney after 12 years of wait list time. My care partner spouse and I quickly gathered up all the supplies needed to conduct hemodialysis in the hospital should the transplanted kidney need some time to "wake up". That pre-transplant preparation turned out to be moot as the cadaveric kidney woke up immediately after its surgical connections were complete. We were ready to "go to the mat" to self-cannulate my then 4 buttonhole sites with the 15 GA BH needles we supplied for as long as it took the kidney to begin functioning. We'll never know the challenges or absence thereof that we may have faced, doing what we had been doing with outstanding success for the prior 10-1/2 years and over 2000 combined short daily and nocturnal home hemodialysis treatments in the comfort and safety of our home.
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  • Sarah Goodwill-Thompson

    Oct 06, 2023 3:20 PM

    Dawn you are an absolute role model to me! I will file this story under WWDD (what would Dawn do?). Still new to being a care partner, but I'm learning to keep my wits about me when things go wrong.
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  • Samantha Arsu

    Sep 16, 2023 9:20 PM

    Love this! You guys are trailblazers!
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  • John

    Sep 15, 2023 1:35 PM

    John from AZ, I was very happy for you guys. You were able to get him to the hospital and jump through hoops to stick him. I cannulate fine but it’s in an easy spot, my wife is too scared to do it but if it came down to it she’d be able to. I mean she watches me every time. I like Jimmy’s pics, one where you know he does not feel well and one where he’s all chill. He’s very lucky to have you. I’m always available but I’m pretty sure you two know more than me. God bless
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